Aeromedical Consultation Service critical to ‘Fly, Fight, Win’

Aeromedical Consultation Service Deputy Chief Dr. Daniel Van Syoc listens during one of four weekly case review sessions in order to determine whether or not a waiver should be recommended for an aviator’s disqualifying medical condition. The ACS reviews approximately 2,000 cases a year with an 88 percent determination of recommendation for waivers, keeping Air Force pilots safely flying. (U.S. Air Force photo/John Harrington)

Ever since humans took to flight, the unique physics and environmental conditions of soaring through the air have tested mankind to overcome challenges, both physical and mental. For U.S. Air Force pilots, aircrew and others, their journey to flight starts with being medically screened.

Every pilot in the Air Force who didn’t graduate from the U.S. Air Force Academy – rough 1,000 annually – has walked through the doors of the Aeromedical Consultation Service for flight evaluation, according to ACS Deputy Chief Dr. Daniel Van Syoc. The academy screens their own pilot candidates, 345 of them in 2016, according to an academy fact sheet.

“Our motto is ‘Fly, Fight, Win.’ That’s what we do,” Van Syoc said. “Everybody who wears the uniform, even (Air Force civilians), are here to directly or indirectly support the flying mission. We play a very critical role in that.”

Currently, the Air Force has 12,600 pilots and 3,297 navigators, according to the Air Force Personnel Center. The strains of flying, medical conditions and even stress can find a pilot facing a disqualifying condition for flight duties. When it does, their case goes to what’s known as a waiver authority to determine if a waiver is possible for the condition; generally this is a major command. When the waiver authority is faced with a case for which they can’t make a determination based on the medical data, it goes to the highly skilled aeromedical experts at the ACS.

A staff of about 80 psychiatrists, neurologists, pulmonologists, cardiologists, general internal medicine doctors, ophthalmologists, psychologists and optometrists, assisted by skilled technicians, carefully review all aspects of a case to determine whether or not to recommend a medical waiver to the waiver authority, the ultimate say on whether a pilot will get to fly again.

“We’re very much a world-class aeromedical evaluation center,” Van Syoc said. “There isn’t really a comparable organization in the world to what we do, that has the ability to go to the lengths that we do in evaluating military aviators.”

To say the professionals at the ACS are at the top of their game may actually be a bit of an understatement.

“I have had the pleasure of working with people who are literally the world expert in what they do,” Van Syoc said.

Today, ACS sees some 2,000 waiver recommendation requests annually. ACS staff can make a waiver recommendation based solely on the case materials in roughly 1,400 of those cases, with the other 600 requiring individuals to be physically seen at the ACS at Wright-Patterson Air Force Base.

“We get sent some of the toughest cases from the field and our job is to make sure that the air crews are flying safely,” said Aeromedical Consultation Service Chief Col. Niraj Govil. “The question that we get is ‘Is this particular flyer safe to fly? If not, if he can’t fly the airframe that he was trained for, where can he go?’ Bottom line, we’re here for the safety of the air crew. What we try to do is return them (to flying status) as safely and as quickly as possible.”

In fact, about 88 percent of the cases ACS reviews ends with a recommendation for waiver to the waiving authority.

“We send the ACS dozens of cases every year: pilots, navigators, enlisted crew members and air traffic controllers,” said Jim J. Cahill, health systems specialist with the Office of the Pacific Air Forces Command Surgeon, who manages primary oversight of all requests for medical waivers on aviators and special-duty personnel from nine PACAF bases. “One of the most important functions they perform for us is to quantify risk. They answer the question, ‘How much risk is associated with allowing this crewmember to continue to fly?’ This is priceless information when the waiver authority is trying to determine if a waiver will be granted.”

To measure that risk, it takes time. Van Syoc says that in the commercial world, a person with a mental health issue might get an hour with a psychiatrist to determine the problem. At the ACS, individuals would meet with both a psychiatrist and psychologist for upwards of 20 hours, not including the time required to review the case materials and research the medical issue. It may seem like a lot of effort, but at a cost of $3 to $5 million to train a fighter pilot, depending on aircraft, Van Syoc says every second is worth it.

“We’ve invested several million dollars in every pilot just to get them to the point where they’re mission ready,” Van Syoc said. “So, if we’re going to invest that kind of money in them and we’re going to say ‘up’ or ‘down’ we want to have covered every aspect of the case and make a very well-informed recommendation to the waiver authority.”

Even with the level of detail the ACS provides, Van Syoc says that once a case comes to them, they can often make a waiver recommendation determination within one month, including for those individuals who need to travel to the ACS to be seen.

To speed up the timeline for waiver authorities to receive a recommendation, the ACS provides specific submission information through online waiver guides – guides they are currently reviewing to ensure they are as clear and specific as possible. As long as all information requested is submitted, the ACS can make a waiver recommendation as quickly as possible.

“Every branch of the ACS, internal medicine, ophthalmology and neuropsychology, provides us with a dedicated consultant we can reach out to any time for the advice we need to support our warfighters,” Cahill said. “The doctors are available pretty much 24/7, which comes in handy considering the challenges of communicating across multiple time zones.”

Cahill says it’s truly a team effort that makes the ACS successful.

“While the docs provide the professional consultation and advice, the case managers are the unsung heroes of the ACS,” Cahill said. “People like Tech. Sgt. Blackwell, Lisa Martin and Dena Green do all of the behind-the-scenes work. They perform the initial review of all cases to ensure everything they need is included, interface with the major command and, in many cases, the referring base, and manage the endless changes to scheduled appointments for our patients.”

While the humans serving as pilots and flight crew haven’t changed much since the ACS first began screening pilots and making waiver recommendations back in the early 1950s, the way they fly has.

“Probably the biggest mission change we’ve been involved with is in remotely piloted aircraft,” Van Syoc said. “A large number of those folks are trained pilots, although not all of them have gone through military pilot training, but that’s the future of the Air Force, the unmanned aircraft. So, we get quite involved in caring for them.”

Besides varying flight missions, changing technology like maneuverable jet nozzles in higher performance aircraft like the F-22 Raptor and F-35 Lightning can subject their pilots to new stressors, according to Govil.

“I think that’s going to broaden our job,” Govil said. “Because, a lot of times we’re waiting for those specific problems that come from the field. Many times, they ask for our advice when they first see problems coming up. What we’re trying to do right now is to enhance our research publishing capabilities, because right now we’re sitting on kind of a goldmine.”

That “goldmine” is the 58,000-some cases in the ACS database reaching back to the 1950s. While ACS staff can access the information located in the database, it’s not as efficient as it could be, according to Govil. Enabling that database to be easier to mine data from is critical to providing research-based recommendations in the future.

“To look at the natural history of a condition in a large group of people, that’s how we end up giving effective advice for policy changes, as far as waivers,” Van Syoc said.

Govil said he doesn’t have a timeline as to when a new form of the database could be ready, but feels confident that not only is it possible, but once done, could be quite significant.

“It looks like it’s going to be the largest data bank of aeromedical information in the world,” he said, which would again set the ACS as the premiere aeromedical evaluation center in the world.

“Behind every pilot, behind every mission, we have people here at ACS who are doing everything we can medically to get them flying,” Govil said. “We’re a critical piece of the ‘Fly, Fight, Win’ mission of the Air Force.”

The ACS is part of the U.S. Air Force School of Aerospace Medicine, the premiere institute for research, education and worldwide operational consultation in aerospace medicine, under the umbrella of the 711th Human Performance Wing, both headquartered at Wright-Patterson AFB.